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Latest revision as of 15:55, 12 January 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Philip Marcus, M.D., M.P.H. [2]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]

Overview

Six minute walk tests act as a predictor of mortality in patients with moderate COPD (patients who desaturate have worse mortality compared with those who don't desaturate.)

Other Diagnostic Studies

Pulmonary Function Test / Spirometry

COPD is particularly characterized if a ratio of forced expiratory volume over 1 second (FEV₁) to forced vital capacity (FVC) being < 0.7 and the FEV₁ < 70% of the predicted value when compared with a matched control. ^[1], ^[2] (see Spirometry).
Normally, at least 70% of the FVC comes out in the first second (i.e. the FEV₁/FVC ratio is >70%). A ratio less than normal defines the patient as having COPD.
More specifically, the diagnosis of COPD is made when the FEV₁/FVC ratio is <70%.
The GOLD criteria also require that values are after bronchodilator medication has been given to make the diagnosis,
The NICE criteria also require FEV1%.
According to the ERS criteria, it is FEV1% predicted that defines when a patient has COPD, that is, when FEV1% predicted is < 88% for men, or < 89% for women.
Spirometry can help to determine the severity of COPD.^[3]
The FEV₁ (measured after bronchodilator medication) is expressed as a percentage of a predicted "normal" value based on a person's age, gender, height and weight:
The severity of COPD also depends on the severity of dyspnea and exercise limitation. These and other factors can be combined with spirometry results to obtain a COPD severity score that takes multiple dimensions of the disease into account.^[4]

COPD Severity

The severity of COPD can be classified as follows using spirometry

Severity	FEV₁ /FVC	FEV₁ % predicted
At risk	>0.7	≥80
Mild COPD	≤0.7	≥80
Moderate COPD	≤0.7	50-80
Severe COPD	≤0.7	30-50
Very Severe COPD	≤0.7	<30 or 30-50 with Chronic Respiratory Failure symptoms

Six Minute Walking Distance

It act as a good predictor of mortality in patients with COPD.
Patients who desaturate during 6MWD have higher mortality compared to those who doesn't desaturate.
This test is a part of BODE index which is used as a mortality predictor for patients with COPD.
The BODE index has the following component
- Body mass index
- Obstruction (FEV1)
- Dyspnea (MMRC dyspnea scale)
- 6 minute walking distance.

Right Sided Heart Catheterization

It is not routinely done. However, in cases when pulmonary hypertension is suspected clinically and on echocardiography then a right heart catheterization can be done to measure pulmonary artery pressure and see the response of vasodilators

References

↑ PatientPlus - Spirometry
↑ [[]]. PMID 22319804. Missing or empty |title= (help); |access-date= requires |url= (help)
↑ Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J (2007). "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary". American Journal of Respiratory and Critical Care Medicine. 176 (6): 532–55. doi:10.1164/rccm.200703-456SO. PMID 17507545. Retrieved 2012-03-02. Unknown parameter |month= ignored (help)
↑ Celli BR, Cote CG, Marin JM; et al. (2004). "The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease". N. Engl. J. Med. 350 (10): 1005–12. doi:10.1056/NEJMoa021322. PMID 14999112. Unknown parameter |month= ignored (help)

Template:WikiDoc Sources

[1] PatientPlus - Spirometry

[pmid22319804-2] [[]]. PMID 22319804. Missing or empty |title= (help); |access-date= requires |url= (help)

[pmid17507545-3] Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J (2007). "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary". American Journal of Respiratory and Critical Care Medicine. 176 (6): 532–55. doi:10.1164/rccm.200703-456SO. PMID 17507545. Retrieved 2012-03-02. Unknown parameter |month= ignored (help)

[Celli04-4] Celli BR, Cote CG, Marin JM; et al. (2004). "The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease". N. Engl. J. Med. 350 (10): 1005–12. doi:10.1056/NEJMoa021322. PMID 14999112. Unknown parameter |month= ignored (help)

[1]

[2]

[3]

[4]

@@ Line 1: / Line 1: @@
+__NOTOC__
 {{Chronic obstructive pulmonary disease}}
 {{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]; {{AOEIC}} {{CZ}}
 ==Overview==
-The diagnosis of COPD is confirmed by [[spirometry]],<ref name="pmid17507545">{{cite journal |author=Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J |title=Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=176 |issue=6 |pages=532–55 |year=2007 |month=September |pmid=17507545 |doi=10.1164/rccm.200703-456SO |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=17507545 |accessdate=2012-03-02}}</ref> a test that measures the forced expiratory volume in one second (FEV<sub>1</sub>), which is the greatest volume of air that can be breathed out in the first second of a large breath. Spirometry also measures the forced vital capacity (FVC), which is the greatest volume of air that can be breathed out in a whole large breath. Normally, at least 70% of the FVC comes out in the first second (i.e. the [[FEV1/FVC|FEV<sub>1</sub>/FVC ratio]] is >70%). A ratio less than normal defines the patient as having COPD.
+Six minute walk tests act as a predictor of mortality in patients with moderate COPD (patients who desaturate have worse mortality compared with those who don't desaturate.)
-[[File:COPD.JPG|thumb|A chest X-ray demonstrating severe COPD. Note the small size of the heart in comparison to the lungs.]]
-==Spirometry==
+==Other Diagnostic Studies==
-* COPD is particularly characterized if a ratio of forced expiratory volume over 1 second ([[FEV1|FEV<sub>1</sub>]]) to [[forced vital capacity]] (FVC) being < 0.7 and the [[FEV1|FEV<sub>1</sub>]]  < 70% of the predicted value when compared with a matched control. <ref>[http://www.patient.co.uk/showdoc/40002357/ PatientPlus - Spirometry]</ref>, <ref name="pmid22319804">{{cite journal |author= |title= |journal=[[]] |volume= |issue= |pages= |year= |pmid=22319804 |doi= |url= |accessdate=2012-03-05}}</ref> (see [[Spirometry]]).
-* Normally, at least 70% of the FVC comes out in the first second (i.e. the [[FEV1/FVC|FEV<sub>1</sub>/FVC ratio]] is >70%). A ratio less than normal defines the patient as having COPD.
+===Pulmonary Function Test / Spirometry===
-* More specifically, the diagnosis of COPD is made when the FEV<sub>1</sub>/FVC ratio is <70%.
-* The GOLD criteria also require that values are after [[bronchodilator]] medication has been given to make the diagnosis,
+*COPD is particularly characterized if a ratio of forced expiratory volume over 1 second ([[FEV1|FEV<sub>1</sub>]]) to [[forced vital capacity]] (FVC) being < 0.7 and the [[FEV1|FEV<sub>1</sub>]]  < 70% of the predicted value when compared with a matched control. <ref>[http://www.patient.co.uk/showdoc/40002357/ PatientPlus - Spirometry]</ref>, <ref name="pmid22319804">{{cite journal |author= |title= |journal=[[]] |volume= |issue= |pages= |year= |pmid=22319804 |doi= |url= |accessdate=2012-03-05}}</ref> (see [[Spirometry]]).
-* The NICE criteria also require FEV1%.
+*Normally, at least 70% of the FVC comes out in the first second (i.e. the [[FEV1/FVC|FEV<sub>1</sub>/FVC ratio]] is >70%). A ratio less than normal defines the patient as having COPD.
-* According to the ERS criteria, it is [[FEV1% predicted]] that defines when a patient has COPD, that is, when FEV1% predicted is < 88% for men, or < 89% for women.
+*More specifically, the diagnosis of COPD is made when the FEV<sub>1</sub>/FVC ratio is <70%.
-* Spirometry can help to determine the severity of COPD.<ref name="pmid17507545">{{cite journal |author=Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J |title=Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=176 |issue=6 |pages=532–55 |year=2007 |month=September |pmid=17507545 |doi=10.1164/rccm.200703-456SO |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=17507545 |accessdate=2012-03-02}}</ref>
+*The GOLD criteria also require that values are after [[bronchodilator]] medication has been given to make the diagnosis,
-*  The FEV<sub>1</sub> (measured after bronchodilator medication) is expressed as a percentage of a predicted "normal" value based on a person's age, gender, height and weight:
+*The NICE criteria also require FEV1%.
-* The severity of COPD also depends on the severity of dyspnea and exercise limitation. These and other factors can be combined with spirometry results to obtain a COPD severity score that takes multiple dimensions of the disease into account.<ref name=Celli04>{{cite journal |author=Celli BR, Cote CG, Marin JM, ''et al.'' |title=The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease |journal=N. Engl. J. Med. |volume=350 |issue=10 |pages=1005–12 |year=2004 |month=March |pmid=14999112 |doi=10.1056/NEJMoa021322 }}</ref>
+*According to the ERS criteria, it is [[FEV1% predicted]] that defines when a patient has COPD, that is, when FEV1% predicted is < 88% for men, or < 89% for women.
+*Spirometry can help to determine the severity of COPD.<ref name="pmid17507545">{{cite journal |author=Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J |title=Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=176 |issue=6 |pages=532–55 |year=2007 |month=September |pmid=17507545 |doi=10.1164/rccm.200703-456SO |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=17507545 |accessdate=2012-03-02}}</ref>
+*The FEV<sub>1</sub> (measured after bronchodilator medication) is expressed as a percentage of a predicted "normal" value based on a person's age, gender, height and weight:
+*The severity of COPD also depends on the severity of dyspnea and exercise limitation. These and other factors can be combined with spirometry results to obtain a COPD severity score that takes multiple dimensions of the disease into account.<ref name="Celli04">{{cite journal |author=Celli BR, Cote CG, Marin JM, ''et al.'' |title=The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease |journal=N. Engl. J. Med. |volume=350 |issue=10 |pages=1005–12 |year=2004 |month=March |pmid=14999112 |doi=10.1056/NEJMoa021322 }}</ref>
+===COPD Severity===
+The severity of COPD can be classified as follows using spirometry
-===The severity of COPD can be classified as follows using spirometry===
 {| class="wikitable" style="text-align:center;width:75%;"
 |-
-! Severity !! Post-bronchodilator FEV1| FEV<sub>1</sub> /FVC !! FEV<sub>1</sub> % predicted
+!Severity!! Post-bronchodilator FEV1 |FEV<sub>1</sub> /FVC!!FEV<sub>1</sub> % predicted
 |-
-| At risk || >0.7 || ≥80
+|At risk||>0.7||≥80
 |-
-| Mild COPD || ≤0.7 || ≥80
+|Mild COPD||≤0.7||≥80
 |-
-| Moderate COPD || ≤0.7 || 50-80
+|Moderate COPD||≤0.7||50-80
 |-
-| Severe COPD || ≤0.7 || 30-50
+|Severe COPD||≤0.7||30-50
 |-
-| Very Severe COPD || ≤0.7 || <30 '''or''' 30-50 with Chronic Respiratory Failure symptoms
+|Very Severe COPD||≤0.7||<30 '''or''' 30-50 with Chronic Respiratory Failure symptoms
 |}
-===Other tests===
+===Six Minute Walking Distance===
-On [[chest x-ray]], the classic signs of COPD are overexpanded lung ([[Hyperaeration|hyperinflation]]), a flattened diaphragm, increased retrosternal airspace, and bullae.<ref name=Old2007>{{cite journal |author=Torres M, Moayedi S |title=Evaluation of the acutely dyspneic elderly patient |journal=Clin. Geriatr. Med. |volume=23 |issue=2 |pages=307–25, vi |year=2007 |month=May |pmid=17462519 |doi=10.1016/j.cger.2007.01.007 |url=}}</ref> It can be useful to help exclude other lung diseases, such as [[pneumonia]], [[pulmonary edema]] or a [[pneumothorax]].<ref name=Old2007/> Complete pulmonary function tests with measurements of lung volumes and gas transfer may also show hyperinflation and can discriminate between COPD with emphysema and COPD without emphysema. A high-resolution [[computed tomography]] scan of the chest may show the distribution of emphysema throughout the lungs and can also be useful to exclude other lung diseases.
-A blood sample taken from an [[artery]], i.e. [[Arterial Blood Gas]] (ABG), can be tested for blood gas levels which may show low oxygen (hypoxaemia) and/or high carbon dioxide (respiratory acidosis if pH is also decreased). A blood sample taken from a [[vein]] may show a high blood count (reactive polycythemia), a reaction to long-term hypoxemia.
+*It act as a good predictor of mortality in patients with [[COPD]].
+*Patients who desaturate during 6MWD have higher mortality compared to those who doesn't desaturate.
+*This test is a part of BODE index which is used as a mortality predictor for patients with COPD.
+*The [[BODE index]] has the following component
+**[[Body mass index]]
+**Obstruction (FEV1)
+**[[Dyspnea]] (MMRC dyspnea scale)
+**6 minute walking distance.
+===Right Sided Heart Catheterization===
+*It is not routinely done. However, in cases when [[pulmonary hypertension]] is suspected clinically and on [[echocardiography]] then a right heart catheterization can be done to measure [[pulmonary artery pressure]] and see the response of [[vasodilator]]s
 ==References==
 {{reflist|2}}
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